Intraductal breast carcinoma: initial results of a morphometric study using computerized digital image analysis

Extensive ductal carcinoma in situ (DCIS) and necrosis in breast carcinoma have been correlated with a higher incidence of local recurrence in patients treated with breast-conserving surgery and radiotherapy. In an attempt quantitatively to assess duct size distribution and necrosis in DCIS, the authors devised a method utilizing computerized digital image analysis. The method and results of a pilot study comparing 21 patients with DCIS, and 21 normal breast specimens are presented. Normal breast tissue from autopsy material revealed a mean duct diameter of 90 microns, whereas the mean diameter of ducts in patients with DCIS was 359 microns (P less than 0.001). The presence of necrosis in DCIS correlated strongly with average duct size. Of the ducts larger than 360 microns in diameter 94% exhibited intraductal necrosis, whereas ducts less than 360 microns showed necrosis in only 30% of the measurements. Ducts with necrosis revealed a mean diameter of 498 microns versus 198 microns in ducts without necrosis (P less than 0.001). The authors suggest that necrosis develops in response to tumour cell hypoxia associated with cross-sectional duct expansion in DCIS. This growth pattern predisposing to tumour cell hypoxia could be a factor contributing to radioresistance and increased local recurrence.